September 15, 2015 Diane Ryan

Partial Hospitalization (PHP)

Myths, Misconceptions and the Mirasol Alternative

If you've ever considered residential eating disorder treatment, your dietitian or therapist may have recommended something called "PHP" or "partial hospitalization".

Mirasol, like many other treatment centers, offers a "partial hospitalization" program, but the name is misleading, and there are a lot of misconceptions about the nature and purpose of the program.

For starters, "partial hospitalization" doesn't mean you'll spend part of the time in a hospital. On the contrary, you'll be living at home or in a comfortable residence with other Mirasol clients!

A few photos of Mirasol's new PHP residence

PHP is often described as a "day" program, but most PHPs actually offer both day and evening programming. It's just that there are fewer hours of individual and group therapy, and more free time to study, work, volunteer in the community, or attend off-site meetings.

In PHP, the focus of therapy shifts from analysis and discovery to development of practical skills that will help you live in the world after treatment without an eating disorder. PHP is often recommended for clients as a step-down from full-time residential treatment, or to provide additional support for clients already in recovery.

"It's the bridge between living in a safe environment and doing the deep core work required at the residential level, and then being able to step aside and apply what you've learned so that you can live your life in recovery," says Mirasol Primary Therapist Katie Klein.

Small is Beautiful (and Baffling)

Mirasol's PHP is very small — never more than six clients in any residence — so treatment plans are highly individualized and adjusted on an almost daily basis to balance the need for support and independence.

"No one's program here looks the same," says Klein. "Some clients need more individual sessions with their primary therapist, while for others we may supplement those sessions with Reiki, polarity therapy, neurofeedback, EMDR or TRE."

There's an average of two process groups a day, with a strong focus on tool and skill development and coping skills through cognitive behavioral therapy, belief work, mindfulness and meditation as well as dialectical behavior therapy, supported by weekly psychodrama, art therapy, poetry and spirituality groups.

Compulsive Exercise: Eating Disorder's Evil Twin

Many clients have an unhealthy relationship with exercise as well as an unhealthy relationship with food. For example, 90% of bulimics exercise to compensate for episodes of binge eating.

"Developing a healthy relationship with exercise is a very important part of the PHP program," says Program Director Nikole Corcoran. "With staff support, clients learn to exercise appropriately, to cope with the feelings that come up when they can't exercise, and to make sure that they're exercising for the right reasons."

Tara Shultis, Massage and Movement Therapist, develops individualized exercise plans for each client, and that means working very closely with our naturopathic physician and dietitians.

"Most clients will attend two yoga classes per week, along with rocks and ropes sessions, trips to the gym and low-flying single-point trapeze. We also offer — weather permitting — bimonthly hiking, caving or backpacking trips."

Keeping It Real in the Kitchen

Of course one of the biggest challenges of transitioning to life after residential treatment is making sure each client has the tools she needs to plan and prepare healthy meals. Corcoran was surprised to discover that some PHP programs don't focus on teaching clients how to properly feed themselves.

"All the food is prepared for them, and sometimes they don't even serve themselves, so they leave treatment knowing what their meal plan is, but with no idea how to implement it. So we put a lot of emphasis not only on food preparation and cooking, but also on breaking down labels and really understanding what those labels mean."

Dietitian Anthony Hackworth meets with clients every Monday to work out a menu plan for the week. He also accompanies the clients on weekly grocery shopping outings to reinforce their healthy food choices and provide assistance with label-reading.

At weekly cooking classes, Mirasol chef Deirdre O'Leary teaches basic cooking skills, including tips on prep work, knife skills, and healthy fats. Deirdre is not only a fantastic chef, but a wonderful entertainer, seasoning her sound advice with entertaining tips for "getting down with your food", letting vegetables "party in the pan" and judicious use of "aerial assault". There's a video of Chef Dee in action on our web site.

"Opportunities to Be Uncomfortable"

The individualization and fluidity of the program are its greatest strengths, but may also be a source of frustration for some clients.

"One of the things PHP can and must provide is the opportunity to be uncomfortable", quips Mirasol's Executive Director Diane Ryan. "That period of transition from the protective cocoon-like environment of residential treatment to life on the outside is the messiest, scariest phase in the recovery process."

In residential treatment, the daily schedule is filled with individual and group therapy sessions, scheduled meals and snacks and recreational activities. Clients are supervised 24/7 to reduce eating disorder cues and triggers, and access to other medicators is severely restricted. In PHP, on the other hand, the daily schedule is deliberately salted with unstructured time and opportunities for clients to make their own choices, including how they'll cope effectively with periods of boredom, indecision, frustration and anxiety.

The ultimate goal is to provide you with opportunities to practice the skills and tools you learned in treatment, with the support of clinical staff and your peers, in an environment as close to real life as possible. There's a sample program schedule on Mirasol's web site at PHP Day Program Schedule.

If you'd like to learn more about Mirasol's PHP program, speak with one of our counselors by calling 888-520-1700 or visit mirasol.net.